New moms on Medicaid are 5 times more likely to die from pregnancy-related causes, but coverage runs out 60 days after childbirth. Illinois officials hope to change that.

Alison Bowen, Chicago Tribune
·6 min read

After childbirth, new moms are vulnerable to many pregnancy-related, life-threatening conditions. Maternal death can happen in the weeks and months following a baby’s arrival.

In Illinois, Medicaid covers women for only 60 days after birth. Health and policy advocates say this leaves women without coverage at a time experts recently recommended adding more care.

Right now, the federal Families First Coronavirus Response Act directs states not to disenroll people from Medicaid, so people should not lose benefits. But typically, after the 60-day period ends, the state assesses whether new moms are eligible for any other Medicaid benefits.

Officials from the state Department of Healthcare and Family Services have applied through the federal Centers for Medicare and Medicaid Services to extend Medicaid coverage to one year postpartum. Of the 73 maternal deaths in Illinois in 2016, 42 women died between 43 days and one year after delivery.

In a letter accompanying their request to extend Medicaid benefits, state officials noted the increasing maternal mortality rate in the U.S. and “alarming” statistics in Illinois, including that 72% of pregnancy-related deaths were considered preventable. Women with Medicaid coverage at delivery were five times more likely to die from a pregnancy-related cause than women with private insurance.

Extending Medicaid coverage “is the single best thing we can do to save moms’ lives and tackle the glaring disparities,” U.S. Rep. Lauren Underwood, D-Ill., said Monday at a news conference.

“We cannot have a conversation about maternal health outcomes in the United States and racial and ethnic health disparities without talking about Medicaid,” added Underwood, who is co-founder of the Black Maternal Health Caucus and has introduced legislation to reduce maternal health disparities.

A new report from The Commonwealth Fund, which promotes a health care system with better access for low-income people, the uninsured and people of color, argues each state should extend Medicaid coverage to moms for at least one year postpartum and include services such as lactation support, doula care, mental health care and family planning.

The report, released Monday, noted that a third of all pregnancy-related deaths in the U.S. from 2011 to 2015 were postpartum. Under an Illinois extension to 12 months, the Commonwealth report estimated about 5,000 women would be covered.

Black women in Illinois are six times more likely to die from pregnancy-related conditions. Experts say that because women of color make up a disproportionate share of Medicaid enrollees, the extension would help narrow health disparities.

Underwood noted that Medicaid covers 43% of births nationwide and more than 65% of births of Black babies. In Illinois, Medicaid covers 44% of births.

Cassie Calderone, a doula with the Healthy Families program at Advocate Illinois Masonic Medical Center, said many moms she works with encounter health issues for weeks and months after birth. For example, Calderone said, a patient with mastitis, a painful breast infection, needs a doctor to diagnose it and prescribe antibiotics. As a new mom breastfeeding a 10-month-old, she is very aware of how pregnancy impacts one’s body for months.

“After you have a baby, things are not the way you left them,” she said, adding that many patients often scramble to fit in appointments before Medicaid ends.

Losing Medicaid just two months after birth places women in a situation where they might be switching providers at a difficult time — juggling a new baby and with limited energy and resources to research and visit a new provider. New moms who cannot pay for out-of-pocket care often turn to free clinics and nonprofit services, according to the report.

Faced with all these challenges, women might prolong finding care, or forgo it altogether, even if they need follow-up appointments or have a chronic illness.

“After birth, it becomes harder for moms to watch out for their own care,” Patricia Lee King, state project director for the Illinois Perinatal Quality Collaborative, said in the report. “They take on the mom role.”

Amber Pendergraph-Leak, a Black mom and doula in South Carolina, was interviewed in the report. At a conference detailing its findings, she spoke about two of her pregnancies — one under Medicaid and another with private insurance.

During her first pregnancy, she recalled an appointment where a doctor didn’t answer her questions. She said she felt she was treated poorly because she was a patient on Medicaid. “It was intimidating for me, because I didn’t know a lot about pregnancy,” she said, “but I did have a lot of questions.”

She also didn’t know her Medicaid coverage would end two months after birth. She did not experience postpartum health issues, which was fortunate, she said, because she had no other coverage.

Seven years later, she was pregnant with her second child. She felt more prepared to advocate for herself. As a patient with private insurance, she said she felt she was taken more seriously. This time, her questions were answered.

“I just felt like I had the elite care,” she said. “I was truly treated like a patient, like not just a number.”

With the second pregnancy, when she needed care after delivery, she was able to see her provider and manage that care in a way she wouldn’t have been able to with her first pregnancy.

In a letter supporting the proposed Illinois extension, the American College of Obstetricians and Gynecologists supports extending Medicaid coverage, saying it “could mean the difference between life and death for our nation’s most vulnerable women.” The group added that extending coverage could help avoid long-term costs because of untreated conditions.

In the letter, ACOG noted that of the 700 pregnancy-related deaths that occur each year in the U.S., one-third happen one week to one year after pregnancy; beyond these deaths, every year about 50,000 women experience a severe health issue as an outcome of labor and delivery.

“ACOG believes that discontinuation of Medicaid coverage is a major contributing factor to the nation’s growing maternal health crisis,” the letter stated. “Illinois has not been immune to this crisis — in fact, maternal mortality and severe maternal morbidity rates in Illinois represent some of the highest in the nation.”

Melissa Simon, an OB-GYN and director of the Institute for Public Health and Medicine at Northwestern’s Feinberg School of Medicine, said Monday at the news conference that extending Medicaid is a clear way to help new moms and babies.

“This is about investing in people, in humans,” she said. “Right now, we’re talking about maternal health and well-being and really reversing these egregious disparities.”

abowen@chicagotribune.com

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